Vol. 209 March 15, 2019, Jargon Update

March 15, 2019

Jargon: “special words or expressions that are used by a particular profession or group and are difficult for others to understand.”

PIV
“Penis In Vagina” intercourse.  Researchers into the sexual activities of people over 65 yo. are using this term to more accurately define a specific sexual act . . .  because they are documenting a wide variety of sexual practices without penile insertion in this age group.

Elderly” is OUT
This term is currently way out of favor. Few “older adults” want to be considered elderly. “Seniors” is acceptable, even though it implies that those under 65 are “juniors”. It may be the association of that word with “discount” that keeps it current. “Perennials”, suggested as a response to the “millennials”, has the connotation that one has to be replanted every spring so it’s failing to stick. “Olders”, “gerontos”, and “third-agers” are distant possibilities. “Older adults” has been adopted by the American Geriatric Society. The American Association of Retired Persons began referring to itself simply as AARP in the late 1990’s . . . about the time it started sending membership invitations to 50 year olds. The Boston Commission on Affairs of the Elderly just changed its name to the Age Strong Commission. (The best candidate for “Best New Politically Correct Term of the Year” award.)

GM/GF
Genetically engineered wheat that contains far less gluten for gluten-free bread that tastes and feels more like real bread has been created using CRISPR gene modifying technology. When it does reach the marketplace it will undoubtedly cause a real purchasing dilemma for a select group of tree huggers.

“Organic”, “natural”, “healthy”
All still remain relatively undefined by the U.S.  Department of Agricultural so any company can put those labels on almost any food. The USDA and the National Organic Standards Board have opposite opinions on the “organic-ness” of carrageenan, a seaweed derived thickening agent. The USDA Organic label does indicate no synthetic pesticides and fertilizers, no genetically modified crops, no chemical processing aids, and no artificial ingredients. A proposed Food Labeling Modernization Act hopes to set uniform, definitive standards in the U.S.

Computer vision
A growing domain of artificial intelligence using “deep learning”, a “type of machine learning that uses multilayered neural networks whose hierarchical computational design is partly inspired by a biologic neuron’s structure.” (1) (Took the words right out of my mouth.) Computer vision can analyze medical images like pictures of skin lesions as well as the work flow in operating rooms or the progression of patient mobility in the ICU.

Moral injury
This is a substitute term for “burn out” in describing what is happening to our physicians.  “The increasingly complex web of medical providers’ highly conflicted allegiances. . . results in the moral injury . . . of not being able to provide high-quality care and healing in the context of health care. . . . Electronic health records track productivity and business metrics, but significantly reduce face-to-face interactions.” (2)

Cisgender
Having a gender identity that is aligned with one’s sex assigned at birth. The opposite of transgender. . . usually, but some transgender persons identify with both genders or neither! (on to the next jargon item.)

Nonbinary
Identifying as neither male or female, having multiple gender identities, or having none; “a more expansive concept of gender.”

Sexual orientation
“Who you go to bed with. Gender is who you go to bed as.”

High-end lobster
Offered by a Maine seafood restaurant that pumped marijuana smoke through the tank water to sedate lobsters before throwing them into the pot. The practice was stopped by order of the state Department of Health for “dispensing of marijuana without a license.”

Standing desks are OUT
A deeper look into the 2015 research of the health benefits of standing vs. sitting while working at a desk indicates that there is little actual health benefit to standing. “Workers should not fool themselves into thinking that standing is a form of exercise.”

Pasture-raised chicken
“Cage-free” chickens may still be raised in packed buildings with no outside access. “Free-range” chickens have outside access but there is no government standard for amount of available space. “Organic” chickens are cage-free, are fed only organic feed, and have outdoor access, but it may be just a small concrete porch. “Pasture-raised” chicken require 108 square feet per bird of outdoor space to earn that label as well as the “Certified Humane” label. (3)

Geroscience
This emerging field of scientific research of longevity hopes to gain the Federal Drug Administration’s attention for reviewing drugs to retard the aging process, which recognizes aging as a natural process (outside their purview) not as a disease (within their jurisdiction for review of new drugs).  A newly formed Boston-based Academy for Health and Lifespan Research will lobby various governments world-wide to support development of drugs and other age-slowing therapies.

“Safe-school officer”
Former combat veterans wearing body armor while carrying a 9mm Glock handgun and a sawed-off automatic rifle hired to roam the halls of the Manatee School for the Arts in Palmetto, Florida. The principal hired the combat veterans because “I don’t want this to be the first time they’ve had someone shooting at them.”

References:
1. NEJM 378;14 April 5, 2018
2. Drs. Talbot and Dean, Boston Globe 8/15/18
3. Consumer Reports On Health, February 2019

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Vol. 195 July 1, 2018 BIG DATA and a whiff of AI in health care

July 1, 2018

Hub thumbnail 2015

“When it comes to health data, Watson hasn’t been much help.”
-STATNEWS, Ross and Swetlitz. Bos Globe 6/18/18

This week all the newspapers (at least in Massachusetts) have been abuzz with the announcement that Atul Gawande, MD has been picked by three moneyed titans of innovation to head their new company to revolutionize health care. Optimism, promise, and hope is in the air! Kind of like when IBM presented Watson, its supercomputer, in 2015 as the tool to provide workable insights into the financial and clinical dilemmas of U.S. hospitals in 2015 via Watson Health.

How is that working out? Watson Health has access to data on tens of millions patients, in part by spending $9 billion to acquire other companies. It’s initial focus was on developing workable products in oncology, designed to help physicians individualize cancer treatments. “With these acquisitions, IBM will be one of the world’s leading health data, analytics, and insights companies, and the only one that can deliver the unique cognitive capabilities of the Watson platform”, said the general manager of Watson Health in 2015.

They (the newly merged companies) struggled with the basic step of learning about the different forms of cancer and the rapidly changing landscape of treatments. Last week Watson Health laid off people partly because, according to some, even Watson had difficulty in digesting all that data. “…They also don’t understand the generation of information, and how it is used, and whether they can do something different with it,” said Robert Burns, professor of health management at U Penn Wharton School. You can almost hear every primary care physician that is struggling to get their new EMR system to give him/her more information and less data cheering loudly in the background, “We couldn’t have said it better!”

The goal of a great deal of innovative technology in health care is “ “zero patient harm”. if Atul can’t do it all with his surgical checklists and Watson can’t do it all with data from tens of millions of patients , what/who can? How about Artificial Intelligence (AI), aka “machine learning”? AI and machine learning is the converting of data into information without the need for human programmers. For instance, if the computer views enough pictures of different dogs, it will learn to correctly identify a cocker spaniel. I think a real test of AI would be to see if it can recognize a Labradoodle,  or any other of the many poodle cross breeds. (Don’t you sometimes worry about the moral standards of poodles that seem to be eager to mate with any kind of passing breed?)

The building of knowledge from patterns in data, both visual and language, is labeled “computer vision”. In some medical studies “computer vision” is used to monitor actual bedside events and identify omissions or non-compliance in procedures. It has apparently improved rapidly beyond just identifying dogs or skin rashes because of “deep learning”: a type of machine learning that uses “multilayered neural networks whose hierarchical computational design is partly inspired by biologic neutron’s structure.” (1)  Got that? Think Google’s self-driving cars. “Computer vision may soon bring us closer to resolving a seemingly intractable mismatch between the growing complexity of intended clinician behavior and human vulnerability to error.” (2)

So, the effort to cut the Gordian knot of patient safety and cost-effective medicine continues. I suspect that the three titans of innovation have turned to Atul Gawande, a health care innovator who successfully uses clinical insight and re-education to effect change, because they recognize the limitations that are becoming more apparent in big data.

  1.  NEJM April 5, 2018 378:14; 1271-2
  2. Ibid.

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